DM Flashcards
What is DM
Chronic condition characterised by abnormal high BG
Why is managing DM important
Prevent microvascular - eye / kidney / nerve complications
Prevent macrovascular - IHD / stroke complications
What are the types of DM
Type 1 Type 2 Gestational MODY Other
What causes type 1
Autoimmune attack on beta cells so destroyed
Results in absolute deficiency of insulin
Genetic + trigger
Associated with other autoimmune conditions
What Ab associated
GAD Ab
How and when does type 1 present
Childhood
Symptomatic or acutely unwell e.g. DKA
Prone to DKA and weight loss
What does type 1 require
Daily insulin or will be fatal
SC or IV
Can’t take oral as will be broken down by gut
What causes type II
Deficiency in insulin due to express adipose insensitivity and pancreas not able to produce enough
B cells normal and may even have hyper insulin
What causes insensitivity
Obesity = increased Fa decreasing insulin sensitivity
If pancreas can’t secrete enough to meet demand will become diabetic
What is the genetic component of type II
Whether pancreas can secrete higher levels
NOT adipose genes or HLA
What is associated with type II
Obesity - central adiposity (reversible) FH Age Ethnicity - south Asian / black Gestational Inactivity
What is MODY
AD genetic disorder affecting B cells and production
Glucokinase / transcription factor mutation
How does MODY tend to present
Younger patient <25
Symptoms similar to type II
DKA not a feature
FH of early onset
What drugs are MODY patient sensitive to
Sulphonylurea - gligliazide
What are other causes of DM
Chronic pancreatitis Haemochromotosis CF Drugs - glucocorticoid Cushing's Acromegaly Phaeochromocytoma Hyperthyroid Pregnancy
How does type 1 present
Polyuria - water dragged out with glucose
Polydipsia
Weight loss
Fatigue
Blurred vision - glucose builds up in from of lens
Thrush / recurrent infection - oral candidiasis
Slow wound healing
DKA
How does type II present
Incidental on bloods Same symptoms as type I Can present with complications Often overweight No ketones
What is needed to diagnose DM
Symptoms + 1+ or 2+ of Blood glucose fasted >7 Random BG >11.1 OGTT >11.1 HbA1c >48
What is OGTT
Take 75g CHO
Take BG before and 2 hours after
What is HbA1c
Tool used to measure long term control
Shows average BG over 3 month period
Dependent on RBC lifespan and average BG
How often should you check
Every 3-6 months until stable then 6 monthly
What causes reduced levels as reduced life span of RBC
Sickle cell
G6PD
Hereditary spherocytosis
Haemolytic anaemia
What causes higher levels as increased RBC lifespan
Vit B12 / folic deficiency
Iron deficiency
Splenectomy
When can HbA1c not be used as diagnostic tool
Type 1 Children Pregnancy If short duration of Sx Acutely ill CKD HIV People on meds that may cause hyperglycaemia - steroid / anti-psychotic Acute pancreatic damage Anaemia's / haemoglobinopathy
